Mum died day after hospital discharge, inquest finds

A mum died from pneumonia less than 24 hours after being discharged from hospital, an inquest has found.

Mental health care assistant Tanya McCartney, 25, died at her Chesterfield home in Derbyshire on 19 May 2023, after being sent home from Chesterfield Royal Hospital with a course of antibiotics.

Returning a narrative conclusion at her inquest, assistant coroner Anita Davis said that the hospital's decision to allow her to return home "contributed to the death".

Kevin Sargen, medical director at Chesterfield Royal Hospital NHS Foundation Trust, said a thorough review had been carried out and improvements made aimed at strengthening patient assessment, escalation and clinical decision-making.

"We would like to again express our sincere condolences to the family and loved ones of Tanya McCartney," said Sargen.

"We accept the findings of the coroner in relation to the care provided in May 2023."

Her mother Natasha Johnson said after the inquest concluded on Monday: "Listening to the coroner formally acknowledge the failures in Tanya's care brings us some closure, but it does not lessen the absolute heartbreak we live with every single day."

She paid tribute to "a beautiful, funny, loving daughter, sister and granddaughter" and "above all, an incredible mum, who lived for her little boy".

"Our family struggled to understand how Tanya could go to hospital desperately unwell and then die the very next day.

"While the hospital has accepted that, had Tanya been admitted she would probably have survived, hearing that is devastating.

"We can only hope that the trust takes the coroner's words to heart so that no other mother has to know their child's death was entirely preventable."

McCartney had gone to hospital on 18 May with chest pains, a cough, elevated heart rate and a fever after being told to go to A&E by her GP.

After tests for suspected chest sepsis, a consultant believed she had an infection and, suspecting this was due to a throat abscess, McCartney was referred to the Ear, Nose and Throat Department.

Instead of being admitted, she was offered the option of being discharged with antibiotics.

McCartney picked up her car from her GP practice and went home, but became "very unwell, showing signs of confusion".

Her family said she had difficulty recognising her partner and son.

Sitting on the sofa, McCartney stopped breathing and an ambulance was called, but despite CPR and the efforts of paramedics, she died.

The inquest at Chesterfield Town Hall concluded: "Had she been admitted on the evening of the 18 May and given appropriate intravenous antibiotics, it is more likely than not that she would have survived."

Law firm Slater and Gordon, representing the family, said that a Chesterfield Royal Hospital NHS Foundation Trust investigation initially found the decision to discharge McCartney was appropriate and an inquest closed in 2023.

But, said Slater and Gordon, after a legal fight, the trust admitted liability and said the decision was inappropriate and the inquest was reopened in February.

Clinical negligence solicitor Rebecca Dowse said: "Tanya's family has shown extraordinary determination in pursuing answers.

"They have had to endure not only the devastating loss of a much-loved daughter and mother, but also years of uncertainty while trying to understand how such a tragedy could occur."

Since McCartney's death, the trust has introduced several changes and learning measures, including strengthened oversight of higher-risk patients within the emergency department, improvements to referral and handover procedures, and the introduction of a new electronic patient record system, said the law firm.

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